Does Medicare Pay for Message-Based E-Visits?

While technology has made healthcare more accessible to the public, it has also created a billing quandary for physicians and other health providers regarding e-visits.

Healthcare was among the many industries that scrambled to find a way to serve its customers during the pandemic, and e-visits solved part of the problem.

As you can imagine, health providers who spend many hours per day answering emails, chatting with patients, and having e-visits, audio visits, and audio-visual visits incur many billable hours. As a result, the Centers for Medicare & Medicaid Services (CMS) made some regulatory changes in response.

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We’ll explain what an e-visit is and answer the question about how Medicare responds to them.

An e-visit is having a conversation with a healthcare provider using chat or messaging technology. It’s the same type of conversation you’d have with the provider if you were in the same room with them. The difference is that both parties are typing messages into a computer rather than directly speaking to them.

Audio-visual visits, audio visits, and e-visits fall under the heading of virtual visits, also known as telehealth visits. These types of visits may be practical for non-emergency visits.

An e-visit includes the initial message, scheduling an e-visit or telehealth visit, and all other communications that are related to an e-visit for a single encounter.

E-visits and texting (also known as SMS, which stands for short messaging service) are considered part of a patient’s medical record.

Healthcare providers commonly implement chat or messaging technology into their healthcare portals to make it convenient for their patients. Patients can utilize the portal to have an electronic visit (e-visit) with their doctor or just get an answer to a quick question.

Because of HIPAA, the health provider must also properly document e-visits by recording notes and updating the patient’s health record. They must complete all these tasks within the required timeframe. Recordkeeping can also include forwarding a summary of the e-visit to the patient’s primary care doctor or medical home and any necessary communications between these parties.

Medicare Regulations and the Impact of COVID

Medicare allowed some types of virtual healthcare services before the pandemic, although they were on a minimal basis. For example, Medicare Parts A and B would cover people living in rural locations and underserved areas with virtual appointments.

Due to the limitations of being able to go anywhere due to pandemic-related safety concerns in 2020, the Department of Health and Human Services (HHS) waived some of the restrictions for telehealth visits for Medicare beneficiaries in March 2020.

These regulations allow patients to get telehealth visits under Medicare for office, hospital, and other health visits. Physical therapy, occupational therapy, speech-language therapy, and auditory therapy are also included as billable services under Medicare.

Unless the government extends them, the new regulations last until December 31, 2024.

Medicare Regulations for E-Visits: 2024 and Beyond

If nothing changes, Medicare beneficiaries will still be able to get certain treatments and services paid for under their Medicare plans, even if they’re not in a rural or underserved area.

At a minimum, the following services will be allowed under Medicare in 2025:

• Home dialysis visits for monthly End-Stage Renal Disease (ESRD)
• Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke at home, in a mobile stroke unit, or anywhere else
• Services to treat a substance use disorder or a co-occurring mental health disorder or for the diagnosis, evaluation, or treatment of a mental health disorder at your home, in a facility, or anywhere else
• Behavioral health services at home and elsewhere
• Diabetes self-management training
• Medicare nutrition therapy

What Is the Future of Medicare E-Visits?

The federal government’s policies regarding e-visits and other telehealth visits are evolving. It is too soon to know whether Medicare coverage for telehealth or e-visits will continue, but a decision will likely be made closer to the end of the year. HHS will make a public announcement when it decides how Medicare will respond to e-visits moving forward.

Does Medicare Advantage Cover E-Visits?

The short answer to whether Medicare Advantage will cover an e-visit depends on whether your specific plan covers them.

Every provider offers different coverages, so the only way to know if your plan will cover a specific type of e-visit is to ask them.

Medicare Advantage Plans and certain providers may also offer more telehealth-related benefits than Original Medicare.

Tips for a Successful E-Visit

To ensure you have a successful e-visit, inquire ahead of time if the service you need will be covered under Medicare. For example, ask whether a virtual check-in, text message, or email message between you and your provider will be covered.

If your service is not covered, inquire how much you will have to pay out of pocket.

Healthcare providers must abide by all HIPAA regulations, so be sure to ask if your e-visit and associated communications comply with HIPAA.

Lastly, make sure you have all the medical records and documentation your health provider will need during your e-visit so you don’t have to look for them or re-contact them.

Stay Informed on Medicare Changes

HHS releases changes and posts updates related to Medicare and Medicare Advantage on their site as changes occur. Medicare beneficiaries will also receive a Plan Annual Notice of Change every year in September. The fall is a good time to review your current plan and determine whether you want to make changes.